Menstrual Irregularities

Menstrual Irregularities Treatment in Turkey: Diagnosing the Root Cause

What causes irregular periods? Learn about the treatment for frequent, delayed, or heavy menstrual bleeding (menorrhagia). Expert management of hormonal disorders and PCOS in Istanbul with Dr. Cengiz Andan.

Resetting Your Body’s Internal Clock

The menstrual cycle is the most vital mirror of a woman’s reproductive health. A regular cycle indicates harmony between hormones and reproductive organs. Conversely, deviations from the expected schedule, changes in bleeding volume, or bleeding between periods are the body’s way of saying, “Something is wrong.”

Menstrual irregularity is not just a “calendar issue.” The underlying cause could range from simple stress to more complex conditions like Polycystic Ovary Syndrome (PCOS), fibroids, thyroid disorders, or even issues that could lead to infertility if left untreated.

At Dr. Cengiz Andan’s Clinic in Istanbul, our approach is not just to mask the irregularity with medication but to find the “underlying root cause” and provide a permanent solution.

1. What is a Normal Menstrual Cycle? Understanding the Limits

To talk about irregularity, we first need to define “normal.” While every woman’s cycle is unique, medical parameters are:

• Frequency: The time between the start of two periods should be between 21 and 35 days.
• Duration: Bleeding should last between 2 to 7 days.
• Volume: Changing 3-4 pads a day is considered normal (Total 30-80 ml).

If your periods come more often than every 21 days, are spaced more than 35 days apart, last longer than 7 days, or involve clots, you should consult a specialist.

2. Types of Irregularities and What They Mean

In medical terms, irregularities have specific names, each pointing to a different problem:

• Oligomenorrhea (Infrequent Periods): Cycles longer than 35 days. (Often a sign of PCOS or perimenopause).
• Polymenorrhea (Frequent Periods): Cycles shorter than 21 days. (Can indicate low ovarian reserve or hormonal imbalance).
• Menorrhagia (Heavy Bleeding): Regular intervals but excessive and prolonged flow. (Often caused by fibroids or adenomyosis).
• Metrorrhagia (Intermenstrual Bleeding): Spotting or bleeding between periods. (Suspicion of polyps or infection).
• Amenorrhea (Absent Periods): No period for more than 3 months.

3. Causes: Hormones or Structure?

The reasons for menstrual irregularities fall into a broad spectrum:

1. Hormonal Causes:

• Polycystic Ovary Syndrome (PCOS): The most common cause. Ovulation laziness leads to delayed periods.
• Thyroid Disorders: Underactive (Hypothyroidism) or overactive (Hyperthyroidism) thyroid disrupts the cycle.
• Hyperprolactinemia: High levels of the milk hormone suppress ovulation.
• Perimenopause: The transition to menopause when ovarian reserve declines.

1. Structural (Anatomical) Causes:

• Fibroids: Benign muscle tumors in the uterus causing heavy bleeding.
• Polyps: Fleshy growths inside the uterus causing spotting.
• Adenomyosis: Thickening of the uterine wall.

1. Lifestyle and Others:

• Excessive stress, rapid weight changes, intense exercise, use of blood thinners, or liver/kidney diseases.

4. Diagnosis: How Do We Identify the Problem?

The diagnostic process is painless and quick:

1. Detailed Ultrasound: To check for uterine wall thickness, fibroids, polyps, or cysts.
2. Hormone Tests: Blood tests done on day 2 or 3 of the cycle (FSH, LH, TSH, Prolactin, E2) to measure ovarian reserve and hormonal balance.
3. Hysteroscopy: If a polyp or suspicious area is seen on ultrasound, a camera is used to look inside the uterus (Diagnostic Hysteroscopy).
4. Endometrial Biopsy: Especially for women over 40 with treatment-resistant bleeding, a tissue sample is taken for pathology.

5. Treatment Options

Treatment is not “giving everyone birth control pills.” It is planned according to the underlying cause.

• Hormonal Regulation: For PCOS or simple hormonal imbalances, birth control pills or progesterone medications re-establish the cycle.
• Hormonal IUD (Mirena): One of the most effective methods for patients with heavy bleeding who also want contraception. It thins the uterine lining, reducing bleeding significantly.
• Surgical Intervention: If the cause is a fibroid or polyp, they are removed via Hysteroscopy (through the vagina) or Laparoscopy (keyhole surgery).
• Lifestyle Changes: Weight loss (especially for PCOS), breaking insulin resistance, and stress management can sometimes restore cycles without medication.

Frequently Asked Questions (FAQ)

1. Does irregular periods cause infertility?Answer:Not directly, but if the irregularity is due to an “ovulation disorder” (e.g., PCOS), it can make conceiving difficult. Once ovulation is regulated with treatment, pregnancy chances return to normal.
2. Do birth control pills cause infertility?Answer:No, this is an urban myth. Birth control pills stop ovulation only while you are taking them. When you stop, fertility returns. In fact, by treating the irregularity, they protect future fertility.
3. Is every delay a problem?Answer:No. Occasional delays once or twice a year due to seasonal changes, high stress, or illness are considered normal. However, if it becomes consistent, you should see a doctor.
4. Is irregularity normal in young girls?Answer:For the first 1-2 years after the first period, irregularities are normal as the brain-ovary communication axis matures. However, if it persists beyond 2 years, it should be investigated.
5. What happens if left untreated?Answer:Prolonged absence of periods can lead to thickening of the uterine lining (hyperplasia) and increase the risk of uterine cancer in the future. Excessive bleeding leads to severe anemia, fatigue, and heart palpitations.

Dr. Cengiz Andan approaches menstrual irregularities with both medical and surgical methods at his clinic in Istanbul, aiming to protect your quality of life and reproductive health.